Surgical lung volume reduction eligibility in an emphysema patient pool referred for endoscopic treatment

Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) are effective treatments for certain patients with severe emphysema. However, treatment access varies across centres, as not all provide both treatment options. We aimed to assess the proportion of severe COPD patients referred for BLVR that could also be eligible for LVRS. A retrospective observational study was performed of the Groningen severe COPD cohort. Strict LVRS criteria included: age ≤ 75 years, BMI between 18 and 32 kg/m2, modified Medical Research Council scale ≥ 2, amount of acute exacerbations ≤ 2, forced expiratory volume in 1 s between 20% and 45% of predicted, residual volume ≥ 150% of predicted, total lung capacity ≥ 100% of predicted, PaCO2 ≤ 8 kPa, PaO2 ≥ 6 kPa, %voxel density score in any lobe ≥ 20% and a heterogeneity index of ≥ 10% (-950HU). Chest CT of the remaining population was visually assessed to determine target zones for surgery and any parenchymal changes contraindicating surgery. In this cohort of 1030 pre-selected patients, 193 (19%) patients met the strict LVRS criteria. Visual chest CT assessment of those patients, excluded 73 patients, resulting in 120 (62%) patients eligible for LVRS. Main factors for exclusion were the absence of approachable surgical targets (18%) and presence of bronchiectasis (10%). Among these eligible patients, 55 (46%) were treated with BLVR. Our analysis indicates that providing LVRS in addition to endoscopic treatment can double therapeutic options for severe emphysema patients, highlighting the importance of offering both treatments to benefit more patients. Patients who visited the UMCG between August 2014 and July 2019 have been included in the Groningen Severe COPD cohort (retrospectively registered at clinicaltrials.gov: NCT04023409 (15/07/2019), an observational cross-sectional cohort with the main aim to identify clinical phenotypes and endotypes in patients with severe COPD.